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HCV-Therapy 2015: V. Keitel Klinik fr Gastroenterologie, - PowerPoint PPT Presentation

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HCV-Therapy 2015: V. Keitel Klinik fr Gastroenterologie, Hepatologie und Infektiologie Direktor: Professor Dr. D. Hussinger Heinrich Heine Universitt Dsseldorf Dsseldorfer HCV cohort GT4 2014 GT4 GT3 GT1 GT1 GT3 GT2 GT2

  1. HCV-Therapy 2015: V. Keitel Klinik für Gastroenterologie, Hepatologie und Infektiologie Direktor: Professor Dr. D. Häussinger Heinrich Heine Universität Düsseldorf

  2. Düsseldorfer HCV cohort GT4 2014 GT4 GT3 GT1 GT1 GT3 GT2 GT2 GT1a GT1a GT1b GT1b 69% GT1 one or more than one therapy 36% GT1 PI-based therapy 76% GT2/3 one or more than one therapy

  3. (DAAs): 02/15 Entnommen aus: Manns & Cornberg, Lancet 2013 NS3/4A Protease Inhibitoren: (-previr) Telaprevir (2011) Adhäsion und Rezeptor-mediierte Endozytose Boceprevir (2011) Simeprevir (2014) Paritaprevir/Ritonavir (2015) Asunaprevir (Japan 2014) Grazoprevir (MK-5172) NS5B Polymerase-Inhibitoren: (-buvir) Sofosbuvir (2014), NI Dasabuvir (2015), NNI Beclabuvir (BMS-791325), NNI NS5A Inhibitoren: (-asvir) Daclatasvir (2014) Ledipasvir (2014 als FDC mit SOF) Ombitasvir (2015 als FDC mit Paritaprevir) Elbasvir (MK-8742)

  4. GT1 w/o Cirrhosis Sofosbuvir (400 mg, NS5B) + 12 Wochen Ledipasvir (90 mg, NS5A) FDC 1/tgl. (Harvoni) Paritaprevir/RT (75/50 mg, NS3/4) + 12 Wochen Ombitasvir 12,5 m (NS5A) FDC (2-0-0) (Viekirax)+ Dasabuvir (250 mg, NS5B) (1-0-1; Exviera) (+ RBV bei GT1a) Sofosbuvir (400 mg, NS5B) + 12 Wochen Daclatasvir (60 mg, NS5A) jew. 1-0-0 (Sovaldi + Daklinza) Sofosbuvir (400 mg, NS5B) + 12 Wochen Simeprevir (150 mg, NS3/4, cave GT1a) jew. 1-0-0 (Sovaldi + Olysio)

  5. GT1 + Cirrhosis Paritaprevir/RT (75/50 mg, NS3/4) + 12 Wochen bei GT1b Ombitasvir 12,5 m (NS5A) FDC (2-0-0) + Dasabuvir (250 mg, NS5B) (1-0-1) + RBV Paritaprevir/RT (75/50 mg, NS3/4) + 24 Wochen bei GT1a Ombitasvir 12,5 m (NS5A) FDC (2-0-0) + Dasabuvir (250 mg, NS5B) (1-0-1) + RBV Sofosbuvir (400 mg, NS5B) + 24 Wochen Ledipasvir (90 mg, NS5A) FDC 1/tgl. (Harvoni) Ggf. + RBV bei dekomp. Zirrhose

  6. No significant significant Compensated cirrhosis fibrosis (F<2) fibrosis(F>2) SOF + RBV SOF + RBV SOF + RBV GT2 12 Wochen 12-16 Wochen 16-20 Wochen SOF + RBV SOF + RBV SOF/LDV + RBV TN 24 Wochen 24 Wochen 24 Wochen GT3 SOF/DCV + RBV SOF/DCV + RBV 24 Wochen 24 Wochen TE SOF/LDV + RBV SOF + peg IFN +RBV 24 Wochen 12 Wochen Viekirax Viekirax 12 Wochen 12 Wochen GT4 SOF/LDV SOF/LDV 12 Wochen 24 Wochen

  7. Therapiemonitoring Baseline: Viruslast, Routinelabor, Fibroscan Woche 3,5: Viruslast (Therapieadhärenz), Routinelabor (Niere, TA) Fibroscan: zur Entscheidung Therapielänge Kontrolle alle 4 Wochen, Viruslast ggf. falls bei Woche 3,5 noch positiv Bei RBV ggf. vorher Schwangerschaftstest, Verhütung bis 6 Monate nach Therapieende

  8. Therapeutische Herausforderungen Patienten mit Zirrhose (DAA Kombinationen besser, ggf. + Ribavirin) Therapie möglichst vor Zirrhosestadium Patienten mit GT 3 und Zirrhose (aktuell niedrigste SVR Raten 60-70%) Patienten mit HIV-Koinfektion Patienten vor und nach LTX Dialysepflichtige Patienten Resistenzentwicklung und Testung (PI, NS5A, weniger bei NS5B) Ökonomischen Herausforderungen Harvoni 22 261 Euro Viekirax 16 995 Euro Exviera 1 655 Euro Sovaldi 19 999 Euro (12 Wochen: 41.000 Euro, GKV Erstattung) Daklinza 13 325 Euro Olysio 9 359 Euro

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